A better place to die: Africa or Scotland?
In this guest blog, Professor Scott Murray, St. Columba’s Hospice Chair of Primary Palliative Care at the University of Edinburgh and Chair of the International Primary Palliative Care Network , highlights some contrasts between end of life care in Kenya and Scotland.
Most people assume that dying in the UK is a more positive experience than dying in an African country, but there is a lot that the UK can learn from Africa.
If you’re dying in Kenya your main experience of living with a terminal illness will usually be of severe and consistent pain. Access to opioid pain relief is inadequate and fails to meet international conventions on access to essential medicines.
Sadly many people in Africa do not have the money to buy pain killers and nurses can’t prescribe morphine. So whether dying from AIDS, cancer or organ failure the main problem is physical: lack of pain and other symptom control.
However, quality of life isn’t always just about pain relief. It's also about physical needs. Societal and existential attitudes to death and dying are very different in Scotland and Kenya.
What makes a better death?
In Kenya, patients often accept their prognosis, and go ahead to make arrangements with their family. One response was: “do the maize and beans ask the harvester where they are going to be stored?” In contrast, in the UK patients are often angry and reluctant to accept their prognosis and seek whatever treatment they can possibly get, even sometimes futile treatment, which can be a real barrier to receiving or seeking palliative care at a time when it can be really helpful.
In Kenya patients often find much comfort and peace and are inspired by their trust that a higher power is in control. In the UK one of the main issues we’ve identified is that people feel spiritual distress and social isolation that sees them deal with their condition and how they’re feeling by “just keeping it to themselves.” In Kenya a supportive community often enables people to die at home despite minimal resourses.
Recently patients and carers are using mobile phones to get support from nurses and volunteers in the community, even in areas where there is no electricity or medicines available.
Experiences from Kenya teach us that community cohesion and talking about our experiences can be vital in ensuring positive experiences of dying, just as experiences from the UK teach of the importance relieving suffering and managing symptoms. They also highlight the potential of mobile phones to support and virtually “be with” patients and families.
Professor Murray is part of the THET Integrate project, a three-year project aimed at strengthening palliative care integration into national health systems in four African countries: Kenya, Rwanda, Uganda and Zambia. Watch Professor Murray talk about project
A final report will be published early next year, and other members of the programme team will be sharing insights from the programme on our blog over the next few months. Read the previous post from Dr Liz Grant, Assistant Principal and Director of the Global Health Academy at the University of Edinburgh.